Rural regions hit hard by dwindling health insurer competition

Rural regions of the country are absorbing the brunt of reduced competition as shifts in the Affordable Care Act exchanges will leave a growing number of counties with just one insurer in the marketplace next year, according to the Wall Street Journal.

More than 650 counties are projected to have just one insurer in 2017, including all of Alaska and Alabama and large portions of Kentucky, Tennessee, Mississippi, Arizona and Oklahoma. In 2016, 225 counties reported having one insurer for ACA plans, leaving regulators and consumers concerned that decreased competition will lead to higher premiums during this year's open enrollment.

Reduced marketplace competition has been fueled by UnitedHealthcare's decision to pull out of the exchange in all but a handful of states following multimillion dollar losses in 2015. Humana is also expected to discontinue ACA plans in several states. According to the WSJ, Premera Blue Cross is leaving a dozen rural counties in Washington, but Aetna and Cigna may expand their current offerings to several other states.

Insurers have been challenged by rural markets that have fewer providers who are less willing to negotiate prices, and because data shows beneficiaries in rural areas rack up higher healthcare costs, according to WSJ.

Studies have shown greater competition in ACA marketplaces generally translates to lower premiums. Last year, health insurer participation remained stable in state marketplaces thanks, in part, to participation rules that encouraged competition.